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2020, 2020 ISAZ. The welfare of aquatic animals is receiving increasing attention around the world, and this should be reflected in the veterinary curricular. Veterinary students in Australia and New Zealand ranked the importance of five pre-selected topics on aquatic animal welfare and ethical issues for newly qualified veterinarians in an online survey. They ranked aquatic animals' health and welfare issues, husbandry techniques of farmed fish, and the use of antibiotics as being of high importance for their first day in practice, with pain and distress associated with angling and trawling practices (fishing) and euthanasia ranking moderate to high. Females assigned more importance to fishing, health and welfare issues, and husbandry techniques of farmed fish than did males. Students in the early stages of study assigned more importance to fishing than did senior students. To the authors' knowledge, this is the first study to investigate what importance veterinary students place on their competence regarding aquatic animal welfare and ethics. Gaining an understanding of how veterinary students prioritize these issues, and if this differs based on gender and stage of study, will help veterinary educators to better prepare graduates to address concerns surrounding the welfare of aquatic animals. This could be achieved by careful consideration of course content and where in the curriculum this material is taught, as well as reiterating key messages in the senior years and addressing changing student attitudes as they progress through the course.

2020 Australian Veterinary Association Background: Hendra virus (HeV) is endemic in Australian flying foxes, posing a threat to equine and human health. Equine vaccination remains the most effective risk mitigation strategy. Many horses remain unvaccinated - even in higher-risk regions. Debate surrounding the vaccine's use is characterised by conflicting perspectives, misunderstanding and mistrust. Private veterinary practitioners are critical to early identification of public health risk through recognition, sampling and management of suspect-equine-HeV-cases. However, managing such cases can be burdensome, with some veterinarians opting not to attend unvaccinated horses or to abandon equine practice because of risk posed by HeV disease and liability. Objective: Ascertain the perspectives of informed citizens on what obligations (if any) private veterinarians have to attend unvaccinated horses with HeV or HeV-like disease. Methods: Three citizens' juries were tasked with considering approaches to managing HeV risk in Australia, including (reported here) roles and obligations of private veterinarians in responding to HeV-suspect-cases. Results: Jurors acknowledged that HeV management posed an important challenge for private veterinarians. A clear majority (27 of 31 jurors) voted that veterinarians should not be obliged to attend unvaccinated horses. All recognised that greater support for veterinarians should be a priority. Conclusions: When informed of HeV risks and strategies for control and management, citizens appreciated the need to support veterinarians performing this critical 'One Health' role for public benefit. The current governance framework within which zoonotic disease recognition and response operates limits the contingency and scope for increasing support and efficacy of these important veterinary public health practices.

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective sys

Background Outbreaks of infectious disease cause serious and costly health and social problems. Two new technologies – pathogen whole genome sequencing (WGS) and Big Data analytics – promise to improve our capacity to detect and control outbreaks earlier, saving lives and resources. However, routinely using these technologies to capture more detailed and specific personal information could be perceived as intrusive and a threat to privacy. Method Four community juries were convened in two demographically different Sydney municipalities and two regional cities in New South Wales, Australia (western Sydney, Wollongong, Tamworth, eastern Sydney) to elicit the views of well-informed community members on the acceptability and legitimacy of: making pathogen WGS and linked administrative data available for public health research using this information in concert with data linkage and machine learning to enhance communicable disease surveillance systems Fifty participants of diverse backgrounds, mixed genders and ages were recruited by random-digit-dialling and topic-blinded social-media advertising. Each jury was presented with balanced factual evidence supporting different expert perspectives on the potential benefits and costs of technologically enhanced public health research and communicable disease surveillance and given the opportunity to question experts. Results Almost all jurors supported data linkage and WGS on routinely collected patient isolates for the purposes of public health research, provided standard de-identification practices were applied. However, allowing this information to be operationalised as a syndromic surveillance system was highly contentious with three juries voting in favour, and one against by narrow margins. For those in favour, support depended on several conditions related to system oversight and security being met. Those against were concerned about loss of privacy and did not trust Australian governments to run secure and effective sys

2019 Elsevier B.V. The World Health Organization's End TB Strategy aims to eliminate tuberculosis (TB) by 2050. Low-burden countries such as Australia are targeted for early elimination (2035), which will require an increase in the intensity and scope of case finding and treatment of people with latent TB infection (LTBI). Because 80 % of TB disease in Australia occurs in metropolitan Sydney (New South Wales) and Melbourne (Victoria), the commitment to move towards elimination has major implications for TB programs in these jurisdictions. We report on a case study analysis that compares and contrasts key attributes of each of these healthcare organizations. Such analysis has important implications for all countries seeking to implement international agreements within local health structures. Differences in the organizational structure, culture and systems of care in NSW and Victoria may facilitate or create barriers to changes in organizational system functions, especially the way in which TB prevention and LTBI treatment is delivered. Ratification of global health treaties and the development of national strategies, alone, is insufficient for realizing the promised outcomes. Even in high income countries, global health agendas such as TB elimination can be complicated by differences in local system structure and funding. As the timelines tighten towards 2035, more work must be done to identify the organizational conditions and service models that will facilitate progress towards TB elimination.

2020 Foundation for the Sociology of Health & Illness This article features a partnership between a veterinary school and a charity that aims to enhance the wellbeing of low-income people. Through this partnership, the charity periodically hosts veterinary clinics for clients and their pets. Even as the veterinarians and veterinary students duly examine people's pets, these pop-up clinics aim to help people and their pets. Hence our analysis revolves around the ethics of 'more-than-human solidarity'. By 'more-than-human solidarity', we mean efforts to help others that either center on or that implicate non-human beings. To delve into the ethical and sociological implications of subsidised veterinary services, and to assist with program planning, we conducted several in-depth interviews with veterinarians. Most substantively, we found that the veterinary school's outreach clinics give rise to multi-species biographical value, which is prized as a pedagogical resource for veterinary students. The veterinarians whom we interviewed felt troubled by the extent to which the pop-up clinics ultimately benefited the veterinary school, but also by the shortage of subsidised veterinary services in the vicinity. Based on these interviews and our own reflections, we invite more scholarship on cultural, economic and political influences that shape the lives of human beings and non-human animals alike.

Background: Public participation in health policy decision making is thought to improve the quality of the decisions and enhance their legitimacy. Citizen/Community Juries (CJs) are a form of public participation that aims to elicit an informed community perspective on controversial topics. Reporting standards for CJ processes have already been proposed. However, less clarity exists about the standards for what constitutes a good quality CJ deliberation-we aim to begin to address this gap here. Methods: We identified the goals that underlie CJs and searched the literature to identify existing frameworks assessing the quality of CJ deliberations. We then mapped the items constituting these frameworks onto the CJ goals; where none of the frameworks addressed one of the CJ goals, we generated additional items that did map onto the goal. Results: This yielded a single operationalized deductive coding framework, consisting of four deliberation elements and four recommendation elements. The deliberation elements focus on the following: jurors' preferences and values, engagement with each other, referencing expert information and enrichment of the deliberation. The recommendation elements focus on the following: reaching a clear and identifiable recommendation, whether the recommendation directly addresses the CJ question, justification for the recommendation and adoption of societal (rather than individual) perspective. To explore the alignment between this framework and the goals underlying CJs, we mapped the operationalized framework onto the transcripts of a CJ. Conclusion: Results suggest that framework items map well onto what transpires in an actual CJ deliberation. Further testing of the validity, generalizability and reliability of the framework is planned.

A One Health approach holds great promise for attenuating the risk and burdens of emerging infectious diseases (EIDs) in both human and animal populations. Because the course and costs of EID outbreaks are difficult to predict, One Health policies must deal with scientific uncertainty, whilst addressing the political, economic and ethical dimensions of communication and intervention strategies. Drawing on the outcomes of parallel Delphi surveys conducted with policymakers in Singapore and Australia, we explore the normative dimensions of two different precautionary approaches to EID decision-making-which we call regimes of risk management and organizing uncertainty, respectively. The imperative to act cautiously can be seen as either an epistemic rule or as a decision rule, which has implications for how EID uncertainty is managed. The normative features of each regime, and their implications for One Health approaches to infectious disease risks and outbreaks, are described. As One Health attempts to move upstream to prevent rather than react to emergence of EIDs in humans, we show how the approaches to uncertainty, taken by experts and decision-makers, and their choices about the content and quality of evidence, have implications for who pays the price of precaution, and, thereby, social and global justice.

Antimicrobial resistance (AMR) is a global crisis with impacts on the future health and welfare of humans and animals. Determining key factors that influence veterinarians' antimicrobial prescribing behaviours can bridge the gap between prescribing guidelines and clinical usage. Veterinarians practicing in Australia were surveyed on their frequency in prescribing different antibiotics; factors influencing their antibiotic prescribing behaviours; and their perceptions of current drivers of AMR. Antibiotics were prescribed in a third of consultations with key differences in the frequency of use of specific antibiotics by small companion animal (SCA), equine and livestock veterinarians, which broadly aligned with antibiotic registration restrictions in Australia. SCA veterinarians reported prescribing broad-spectrum antibiotics of higher importance to human health more frequently than livestock veterinarians. Factors that were reported as 'strong' or 'moderate' barriers to appropriate antibiotic prescribing were the 1) cost of culture and susceptibility testing and 2) lack of access to rapid and affordable diagnostic tests. Fear of losing clients, colleague pressure, and lack of their own understanding about antibiotics were considered to be 'no' or 'somewhat' of a barrier to appropriate prescribing by respondents. SCA veterinarians placed greater importance on the contribution of antibiotic use in livestock to AMR, than antibiotic use in companion animals. Despite reporting use of fewer, mostly narrow spectrum antibiotics of lower importance to human and animal health, livestock veterinarians were generally more aware of their potential contribution to AMR. This study provides insights into the similarities and differences in SCA, equine and livestock veterinarians practicing in Australia and informs sector-specific strategies to improve antimicrobial stewardship.

Surveillance is essential for communicable disease prevention and control. Traditional notification of demographic and clinical information, about individuals with selected (notifiable) infectious diseases, allows appropriate public health action and is protected by public health and privacy legislation, but is slow and insensitive. Big data-based electronic surveillance, by commercial bodies and government agencies (for profit or population control), which draws on a plethora of internet- and mobile device-based sources, has been widely accepted, if not universally welcomed. Similar anonymous digital sources also contain syndromic information, which can be analysed, using customised algorithms, to rapidly predict infectious disease outbreaks, but the data are nonspecific and predictions sometimes misleading. However, public health authorities could use these online sources, in combination with de-identified personal health data, to provide more accurate and earlier warning of infectious disease events-including exotic or emerging infections-even before the cause is confirmed, and allow more timely public health intervention. Achieving optimal benefits would require access to selected data from personal electronic health and laboratory (including pathogen genomic) records and the potential to (confidentially) re-identify individuals found to be involved in outbreaks, to ensure appropriate care and infection control. Despite existing widespread digital surveillance and major potential community benefits of extending its use to communicable disease control, there is considerable public disquiet about allowing public health authorities access to personal health data. Informed public discussion, greater transparency and an ethical framework will be essential to build public trust in the use of new technology for communicable disease control.

Background: Public participation in health policy decision making is thought to improve the quality of the decisions and enhance their legitimacy. Citizen/Community Juries (CJs) are a form of public participation that aims to elicit an informed community perspective on controversial topics. Reporting standards for CJ processes have already been proposed. However, less clarity exists about the standards for what constitutes a good quality CJ deliberation-we aim to begin to address this gap here. Methods: We identified the goals that underlie CJs and searched the literature to identify existing frameworks assessing the quality of CJ deliberations. We then mapped the items constituting these frameworks onto the CJ goals; where none of the frameworks addressed one of the CJ goals, we generated additional items that did map onto the goal. Results: This yielded a single operationalized deductive coding framework, consisting of four deliberation elements and four recommendation elements. The deliberation elements focus on the following: jurors' preferences and values, engagement with each other, referencing expert information and enrichment of the deliberation. The recommendation elements focus on the following: reaching a clear and identifiable recommendation, whether the recommendation directly addresses the CJ question, justification for the recommendation and adoption of societal (rather than individual) perspective. To explore the alignment between this framework and the goals underlying CJs, we mapped the operationalized framework onto the transcripts of a CJ. Conclusion: Results suggest that framework items map well onto what transpires in an actual CJ deliberation. Further testing of the validity, generalizability and reliability of the framework is planned.

The essence of One Health, as described in Chapter 2, is the interdependence of human, animal, and environmental health. Greater recognition of these co-dependencies will ensure that interventions designed to protect health or mitigate disease threats in one sector will not have unintended or disproportionate adverse consequences for others. This interdependence raises ethical questions about how to balance competing values and priorities within and between different sectors.

Emerging infectious diseases (EIDs) remain a significant and dynamic threat to the health of individuals and the well-being of communities across the globe. Over the last decade, in response to these threats, increasing scientific consensus has mobilised in support of a One Health (OH) approach so that OH is now widely regarded as the most effective way of addressing EID outbreaks and risks. Given the scientific focus on OH, there is growing interest in the philosophical and ethical dimensions of this approach, and a nascent OH literature is developing in the humanities. One of the key issues raised in this literature concerns ethical frameworks and whether OH merits the development of its very own ethical framework. In this paper, we argue that although the OH approach does not demand a new ethical framework (and that advocates of OH can coherently adhere to this approach while deploying existing ethical frameworks), an OH approach does furnish the theoretical resources to support a novel ethical framework, and there are benefits to developing one that may be lost in its absence. We begin by briefly explaining what an OH approach to the threats posed by EIDs entails before outlining two different ways of construing ethical frameworks. We then show that although on one account of ethical frameworks there is no need for OH to generate its own, there may be advantages for its advocates in doing so.

The essence of One Health, as described in Chapter 2, is the interdependence of human, animal, and environmental health. Greater recognition of these co-dependencies will ensure that interventions designed to protect health or mitigate disease threats in one sector will not have unintended or disproportionate adverse consequences for others. This interdependence raises ethical questions about how to balance competing values and priorities within and between different sectors.

Background: Event-based social media monitoring and pathogen whole genome sequencing (WGS) will enhance communicable disease surveillance research and systems. If linked electronically and scanned systematically, the information provided by these technologies could be mined to uncover new epidemiological patterns and associations much faster than traditional public health approaches. The benefits of earlier outbreak detection are significant, but implementation could be opposed in the absence of a social licence or if ethical and legal concerns are not addressed. Methods: A three-phase mixed-method Delphi survey with Australian policy-makers, health practitioners and lawyers (n = 44) was conducted to explore areas of consensus and disagreement over (1) key policy and practical issues raised by the introduction of novel communicable disease surveillance programmes; and (2) the most significant and likely risks from using social media content and WGS technologies in epidemiological research and outbreak investigations. Results: Panellists agreed that the integration of social media monitoring and WGS technologies into communicable disease surveillance systems raised significant issues, including impacts on personal privacy, medicolegal risks and the potential for unintended consequences. Notably, their concerns focused on how these technologies should be used, rather than how the data was collected. Panellists held that social media users should expect their posts to be monitored in the interests of public health, but using those platforms to contact identified individuals was controversial. The conditions of appropriate use of pathogen WGS in epidemiological research and investigations was also contentious. Key differences amongst participants included the necessity for consent before testing and data-linkage, thresholds for action, and the legal and ethical importance of harms to individuals and commercial entities. The erosion of public trust was seen as the most s

As practitioners and policy makers struggle to manage the risks and harms of overdiagnosis, Chris Degeling and colleagues contend that citizens' juries offer a way forward

Emerging infectious diseases (EIDs) remain a significant and dynamic threat to the health of individuals and the well-being of communities across the globe. Over the last decade, in response to these threats, increasing scientific consensus has mobilised in support of a One Health (OH) approach so that OH is now widely regarded as the most effective way of addressing EID outbreaks and risks. Given the scientific focus on OH, there is growing interest in the philosophical and ethical dimensions of this approach, and a nascent OH literature is developing in the humanities. One of the key issues raised in this literature concerns ethical frameworks and whether OH merits the development of its very own ethical framework. In this paper, we argue that although the OH approach does not demand a new ethical framework (and that advocates of OH can coherently adhere to this approach while deploying existing ethical frameworks), an OH approach does furnish the theoretical resources to support a novel ethical framework, and there are benefits to developing one that may be lost in its absence. We begin by briefly explaining what an OH approach to the threats posed by EIDs entails before outlining two different ways of construing ethical frameworks. We then show that although on one account of ethical frameworks there is no need for OH to generate its own, there may be advantages for its advocates in doing so.

There is increasing scientific consensus that a One Health approach (acknowledging links between human, animal and environmental health) is the most effective way of responding to emerging infectious disease (EID) threats. However, reviews of past EID events show that successful implementation of control strategies hinge on alignment with public values. Given the limited evidence about public values in this area, we sought to understand public preferences for attributes associated with One Health strategies for EID prevention and control, using a discrete choice experiment (DCE). The DCE was conducted in 2016 using an online panel of Australian respondents aged over 18. Participants were presented with 18 pairs of scenarios describing One Health strategies and outcomes, and asked to select their preferred one. Scenarios were described by nine attributes with varying levels: personal autonomy, economic development, environmental health, community cohesion, free trade and travel, zoonotic risk, mortality, animal welfare and food security. Respondents were broadly representative of the Australian population (n = 1999, mean age 45.3 years (range 18-89); 50.7% male). The public preferred scenarios in which individual freedoms are not restricted for the greater good; unemployment is low; the environment is healthy; there is good community cohesion; travel, imports and exports are tightly controlled; there is lower mortality and incidence of disease; and where animal welfare and food security are protected. Although lower morbidity and mortality were preferable, respondents were willing to accept extra cases of severe disease and deaths to avoid reductions in some attributes. However, a mixed logit model indicated significant heterogeneity. A latent class analysis suggested wide variability across respondent classes in the valuation of attributes, and the trade-offs respondents were willing to accept. Therefore, a single approach to managing EID using One Health is unlikel

As practitioners and policy makers struggle to manage the risks and harms of overdiagnosis, Chris Degeling and colleagues contend that citizens' juries offer a way forward

STUDY QUESTION Does an informed group of citizens endorse the clinical use of mitochondrial donation in a country where this is not currently permitted? SUMMARY ANSWER After hearing balanced expert evidence and having opportunity for deliberation, a majority (11/14) of participants in a citizens' jury believed that children should be able to be born using mitochondrial donation. WHAT IS KNOWN ALREADY Research suggests that patients, oocyte donors and health professionals support mitochondrial donation to prevent transmission of mitochondrial disease. Less is known about public acceptability of this novel reproductive technology, especially from evidence using deliberative methods. STUDY DESIGN, SIZE, DURATION This study comprised a citizens' jury, an established method for determining the views of a well-informed group of community members. The jury had 14 participants, and ran over one and a half days in 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS Jurors were members of the public with no experience of mitochondrial disease. They heard and engaged with relevant evidence and were asked to answer the question: Should Australia allow children to be born following mitochondrial donation?' MAIN RESULTS AND THE ROLE OF CHANCE Eleven jurors decided that Australia should allow children to be born following mitochondrial donation; 7 of whom added conditions such as the need to limit who can access the intervention. Three jurors decided that children should not (or not yet) be born using this intervention. All jurors were particularly interested in the reliability of evidence, licensing/regulatory mechanisms and the rights of children to access information about their oocyte donors. LIMITATIONS, REASONS FOR CAUTION Jurors' views were well informed and reflected critical deliberation and discussion, but are not intended to be representative of the whole population. WIDER IMPLICATIONS OF THE FINDINGS When presented with high quality evidence, combined with opportunities to

Background: Event-based social media monitoring and pathogen whole genome sequencing (WGS) will enhance communicable disease surveillance research and systems. If linked electronically and scanned systematically, the information provided by these technologies could be mined to uncover new epidemiological patterns and associations much faster than traditional public health approaches. The benefits of earlier outbreak detection are significant, but implementation could be opposed in the absence of a social licence or if ethical and legal concerns are not addressed. Methods: A three-phase mixed-method Delphi survey with Australian policy-makers, health practitioners and lawyers (n = 44) was conducted to explore areas of consensus and disagreement over (1) key policy and practical issues raised by the introduction of novel communicable disease surveillance programmes; and (2) the most significant and likely risks from using social media content and WGS technologies in epidemiological research and outbreak investigations. Results: Panellists agreed that the integration of social media monitoring and WGS technologies into communicable disease surveillance systems raised significant issues, including impacts on personal privacy, medicolegal risks and the potential for unintended consequences. Notably, their concerns focused on how these technologies should be used, rather than how the data was collected. Panellists held that social media users should expect their posts to be monitored in the interests of public health, but using those platforms to contact identified individuals was controversial. The conditions of appropriate use of pathogen WGS in epidemiological research and investigations was also contentious. Key differences amongst participants included the necessity for consent before testing and data-linkage, thresholds for action, and the legal and ethical importance of harms to individuals and commercial entities. The erosion of public trust was seen as the most s

Objective To elicit informed views from Australian women aged 70-74 regarding the acceptability of ceasing to invite women their age to participate in government-funded mammography screening (BreastScreen). Design Two community juries held in 2017. Setting Greater Sydney, a metropolis of 4.5 million people in New South Wales, Australia. Participants 34 women aged 70-74 with no personal history of breast cancer, recruited by random digit dialling and previously randomly recruited list-based samples. Main outcomes and measures Jury verdict and rationale in response to structured questions. We transcribed audio-recorded jury proceedings and identified central reasons for the jury's decision. Results The women's average age was 71.5 years. Participants were of diverse sociocultural backgrounds, with the sample designed to include women of lower levels of educational attainment. Both juries concluded by majority verdict (16-2 and 10-6) that BreastScreen should continue to send invitations and promote screening to their age group. Reasons given for the majority position include: (1) sending the invitations shows that society still cares about older women, empowers them to access preventive health services and recognises increasing and varied life expectancy; (2) screening provides women with information that enables choice and (3) if experts cannot agree, the conservative approach is to maintain the status quo until the evidence is clear. Reasons for the minority position were the potential for harms through overdiagnosis and misallocation of scarce health resources. Conclusions Preventive programmes such as mammography screening are likely to have significant symbolic value once they are socially embedded. Arguments for programme de-implementation emphasising declining benefit because of limited life expectancy and the risks of overdiagnosis seem unlikely to resonate with healthy older women. In situations where there is no consensus among experts on the value of establi

Objective To elicit informed views from Australian women aged 70-74 regarding the acceptability of ceasing to invite women their age to participate in government-funded mammography screening (BreastScreen). Design Two community juries held in 2017. Setting Greater Sydney, a metropolis of 4.5 million people in New South Wales, Australia. Participants 34 women aged 70-74 with no personal history of breast cancer, recruited by random digit dialling and previously randomly recruited list-based samples. Main outcomes and measures Jury verdict and rationale in response to structured questions. We transcribed audio-recorded jury proceedings and identified central reasons for the jury's decision. Results The women's average age was 71.5 years. Participants were of diverse sociocultural backgrounds, with the sample designed to include women of lower levels of educational attainment. Both juries concluded by majority verdict (16-2 and 10-6) that BreastScreen should continue to send invitations and promote screening to their age group. Reasons given for the majority position include: (1) sending the invitations shows that society still cares about older women, empowers them to access preventive health services and recognises increasing and varied life expectancy; (2) screening provides women with information that enables choice and (3) if experts cannot agree, the conservative approach is to maintain the status quo until the evidence is clear. Reasons for the minority position were the potential for harms through overdiagnosis and misallocation of scarce health resources. Conclusions Preventive programmes such as mammography screening are likely to have significant symbolic value once they are socially embedded. Arguments for programme de-implementation emphasising declining benefit because of limited life expectancy and the risks of overdiagnosis seem unlikely to resonate with healthy older women. In situations where there is no consensus among experts on the value of establi

Australia is currently canine rabies free; however, the spread of rabies in eastern Indonesia poses an increasing risk to northern Australia. Domestic dogs are numerous in East Arnhem Land (EAL) and the Northern Peninsular Area (NPA), usually unrestrained and living in close relationships with humans. The response to any rabies outbreak on Australian territory will focus on dog vaccination, controlling dog movements and depopulation. A One Health approach to zoonotic disease control should seek to co-promote human and animal health, whilst also seeking to accommodate the preferences of affected communities. We report on 5 collaborative workshops and 28 semi-structured interviews conducted between January 2017 and June 2018 with: (i) EAL and NPA community members; (ii) Indigenous Rangers in EAL and NPA; and (iii) residents of Cairns, the local regional centre. Storyboard methodologies were used to work with participants and explore what rabies response measures they thought were justified or unacceptable, why they held these views, and what other steps they believed needed to be taken. Key findings include that the capacity of the NPA and EAL communities to contribute/adapt to a biosecurity response is limited by structural disadvantage including poor infrastructure (such as lockable premises and intact fences) and appropriate information, dominant cultural norms and food security concerns. Dogs and dingoes can have great cultural and social importance; key interventions might be accommodated within cultural beliefs and long-standing norms of dog management if sufficient effort is made to adapt interventions to local contexts and community preferences. Adopting such a 'strengths-based' approach mandates that the communities at greatest risk need help to prepare for and develop strategies to manage a biosecurity response to a rabies incursion. This would include listening to individual and community concerns and attending to the educational and infrastructural needs f

BACKGROUND: Hendra virus (HeV) infection is endemic in Australian flying-fox populations. Habitat loss has increased the peri-urban presence of flying-foxes, increasing the risk of contact and therefore viral 'spillovers' into horse and human populations. An equine vaccine is available and horse-husbandry practices that minimize HeV exposure are encouraged, but their adoption is suboptimal. Ecological approaches-such as habitat creation and conservation-could complement vaccination and behavioural strategies by reducing spillover risks, but these are controversial. METHODS: We convened three community juries (two regional; one metropolitan) to elicit the views of well-informed citizens on the acceptability of adding ecological approaches to current interventions for HeV risk. Thirty-one participants of diverse backgrounds, mixed genders and ages were recruited using random-digit-dialling. Each jury was presented with balanced factual evidence, given time to ask questions of expert presenters and, after deliberation, come to well-reasoned conclusions. RESULTS: All juries voted unanimously that ecological strategies should be included in HeV risk management strategies but concluded that current interventions-including vaccination and changing horse-husbandry practices-must remain the priority. The key reasons given for adopting ecological approaches were: (i) they address underlying drivers of disease emergence, (ii) the potential to prevent spillover of other bat-borne pathogens, and (iii) there would be broader community benefits. Juries differed regarding the best mechanism to create/conserve flying-fox habitat: participants in regional centres favoured direct government action, whereas the metropolitan jury preferred to place the burden on landholders. CONCLUSIONS: Informed citizens acknowledge the value of addressing the drivers of bat-borne infectious risks but differ substantially as to the best implementation strategies. Ecological approaches to securing bat h

The importance of animal welfare and ethics (AWE) within the veterinary education should reflect community concerns and expectations about AWE, and the professional demands of veterinary accreditation on the first day of practice (or 'Day One' competences). Currently, much interest and debate surrounds the treatment of production animals, particularly around live export. To explore the attitudes to AWE of veterinary students in Australia and New Zealand, a survey was undertaken to (i) understand what students consider important AWE topics for initial production animal competence; and (ii) ascertain how these priorities correlated with gender, area of intended practice and stage-of-study. The results from 575 veterinary students showed that all students ranked strategies to address painful husbandry procedures as the most important issues on their first day in production animal practice. Additionally, it was found that the importance students assigned to an understanding of human-animal interactions declined as they progressed through the veterinary course. In contrast, the importance of an understanding of euthanasia issues for production animals increased for male students as they progressed through the course, and remained consistently high in females. Females also gave higher ranking to the importance of understanding production animal stress associated with transport, and ranked strategies to address painful husbandry procedures more important than did males. These findings should help the development of AWE teaching resources that address students' attitudes and competence and that can be delivered when students are most receptive.

Veterinarians are in a strong position of social influence on animal-related issues. Hence, veterinary schools have an opportunity to raise animal health and welfare standards by improving veterinary students' animal welfare and ethics (AWE) education, including that related to animals used for scientific purposes. A survey of 818 students in the early, mid, and senior stages of their courses at all eight veterinary schools across Australia and New Zealand was undertaken on their first day of practice (or Day One Competences) to explore how veterinary students viewed the importance of their competence in the management of welfare and ethical decision-making relating to animals kept for scientific purposes. From highest to lowest, the rankings they assigned were: Animal Ethics Committee (AEC) Procedures or Requirements; 3Rs (Replacement, Refinement and Reduction); Humane Endpoints; Euthanasia; "What Is a Research Animal?" and Conscientious Objections. Female students rated Conscientious Objections, Humane Endpoints, and Euthanasia significantly higher than male students did across the three stages of study. The score patterns for these three variates showed a trend for the male students to be more likely to score these topics as extremely important as they advanced through the course, but female students' scores tended to decline slightly or stay relatively stable. No gender differences emerged for the three variates: 3Rs (Replacement, Refinement and Reduction); AEC Procedures or Requirements; and "What Is a Research Animal?". This study demonstrates that understandings of the regulatory and normative frameworks are considered most important in animal welfare and ethics competence in veterinary students. To the authors' knowledge, this is the first study to investigate what importance veterinary students place on their competence regarding animals kept for scientific purposes.

Objectives: To explore and compare the knowledge, attitudes and experiences of doctors, dentists and veterinarians (as prescribers) in relation to antibiotic use and antibiotic resistance (AbR), and to consider the implications of these for policy-making that support a One Health approach. Design: A cross-sectional survey conducted online. Setting: Doctors, dentists and veterinarians practising in primary, secondary or tertiary care in Australia. Participants: 547 doctors, 380 dentists and 403 veterinarians completed the survey. Main outcome measures: Prescribers' knowledge, attitudes and perceptions of AbR, the extent to which a range of factors are perceived as barriers to appropriate prescribing practices, and perceived helpfulness of potential strategies to improve antibiotic prescribing in practice. Results: There was substantial agreement across prescriber groups that action on AbR is required by multiple sectors and stakeholders. However, prescribers externalised responsibility to some extent by seeing the roles of others as more important than their own in relation to AbR. There were common and context-specific barriers to optimal prescribing across the prescriber groups. Prescriber groups generally perceived restrictive policies as unhelpful to supporting appropriate prescribing in their practice. Conclusions: The results have implications for implementing a One Health approach that involves doctors, dentists and veterinarians as key players to tackling the crisis of AbR. The findings are that (1) prescribers understand and are likely receptive to a One Health policy approach to AbR, (2) policy development should be sensitive to barriers that are specific to individual prescriber groups and (3) the development and introduction of interventions that might be perceived as reducing prescriber autonomy will need to be carefully designed and implemented.

Objective: To elicit the views of well-informed community members on the acceptability of proposed policy interventions designed to improve community use of antibiotics in Australia. Design: Two community juries held in 2016. Setting and participants: Western Sydney and Dubbo communities in NSW, Australia. Twenty-nine participants of diverse social and cultural backgrounds, mixed genders and ages recruited via public advertising: one jury was drawn from a large metropolitan setting; the other from a regional/rural setting. Main outcome measure: Jury verdict and rationale in response to a prioritization task and structured questions. Results: Both juries concluded that potential policy interventions to curb antibiotic misuse in the community should be directed towards: (i) ensuring that the public and prescribers were better educated about the dangers of antibiotic resistance; (ii) making community-based human and animal health-care practitioners accountable for their prescribing decisions. Patient-centred approaches such as delayed prescribing were seen as less acceptable than prescriber-centred approaches; both juries completely rejected any proposal to decrease consumer demand by increasing antibiotic prices. Conclusion: These informed citizens acknowledged the importance of raising public awareness of the risks, impacts and costs of antibiotic resistance and placed a high priority on increasing social and professional accountability through restrictive measures. Their overarching aim was that policy interventions should be directed towards creating collective actions and broad social support for changing antibiotic use through establishing and explaining the need for mechanisms to control and support better prescribing by practitioners, while not transferring the burdens, costs and risks of interventions to consumers.

In this qualitative study implemented in November 2016, we elicited narratives about fictional rabies incursions from key employees (n = 16) of the National Agriculture and Quarantine Inspection Authority in Papua New Guinea (PNG) to explore the potential circumstances and routes of entry of a rabies-infected dog, and direct rabies preparedness. Although PNG is rabies free, proximity to rabies-endemic Indonesia poses a risk of introduction and it is expected that an outbreak in PNG would have devastating human health impacts consistent with other countries with similarly low human development indices and abundant free-roaming dogs. Participants used their local and professional knowledge to create plausible narratives in response to contextual, but fictitious, newspaper stories. An ethnographic content analysis was used to extract themes and interpret the narratives. Themes were assessed in the context of their potential influence on rabies preparedness in PNG against the social and political background of PNG and relevant, published literature. Consistent themes included the ubiquity of trade and the complexity of routes between Indonesia and PNG. Dog ownership seemed pragmatic - actors in the narratives readily and rationally involved dogs in transactions in response to trade, exchange or gifting opportunities. Consequently, dogs changed ownership frequently. The findings of this study have important implications for rabies preparedness in PNG; there is potential for wide geographic dissemination of rabies in dogs before outbreak detection. However, common patterns of travel - trade of dogs via Papuan towns and use of traditional trade routes - do provide opportunity for targeted surveillance and response in the event of an incursion.

Dog-bites and rabies are neglected problems worldwide, notwithstanding recent efforts to raise awareness and to consolidate preventive action. As problems, dog-bites and rabies are entangled with one another, and both align with the concept of One Health. This concept emphasizes interdependence between humans and non-human species in complex socio-ecological systems. Despite intuitive appeal, One Health applications and critiques remain under-developed with respect to social science and social justice. In this article, we report on an ethnographic case-study of policies on dog bites and rabies, with a focus on Calgary, Alberta, Canada, which is widely recognized as a leader in animal-control policies. The fieldwork took place between 2013 and 2016. Our analysis suggests that current policies on rabies prevention may come at the expense of a 'bigger picture' for One Health. In that 'bigger picture,' support is needed to enhance coordination between animal-control and public-health policies. Such coordination has direct relevance for the well-being of children, not least Indigenous children.

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide, and the burdens of this disease continue to track prior disadvantage. In order to galvanise a coordinated global res ponse, WHO has recently launched the End TB Campaign that aims to eliminate TB by 2050. Key to this is the introduction of population screening programmes in low-burden settings to identify and treat people who have latent TB infection (LTBI). The defining features of LTBI are: that it is not an active disease but confers an increased risk of disease; the socially disadvantaged are those most in danger and uncertainty persists as to who will be harmed or benefitted from screening-led prophylactic interventions. Systematic screening programmes that include surveillance, case-finding and treatment of asymptomatic individuals inevitably redistribute the risk of harms and the potential for benefits within a population. The extent to which those targeted within such programmes should be exposed to higher levels of risk in the pursuit of individual or community benefits requires careful consideration prior to implementation. As currently construed, it remains unclear who stands to benefit most from how LTBI screening in high-income countries is being organised, and whose health is being prioritised: members of disadvantaged groups or the broader community. Unless the aims of LTBI screening programmes in these settings are made transparent and their prioritisation ethically justified, there is a significant danger that such a targeted intervention will further disadvantage those who have the least capacity to bear the burdens of TB elimination.

The merits of students exchanging views through the so-called human continuum exercise (HCE) are well established. The current article describes the creation of the virtual human continuum (VHC), an online platform that facilitates the same teaching exercise. It also reports feedback on the VHC from veterinary science students (n = 38). First-year Doctor of Veterinary Medicine students at the University of Sydney, Australia, trialed the platform and provided feedback. Most students agreed or strongly agreed that the VHC offered: a non-threatening environment for discussing emotive and challenging issues; and an opportunity to see how other people form ideas. It also made them think about how to express their ideas and make arguments; and left them feeling more comfortable about expressing their views using it than they would discussing ideas face-to-face (98%, 84%, 79% and 76%, respectively). All respondents agreed or strongly agreed that the VHC encouraged them to consider other opinions. These data suggest that the transition of the HCE to an online platform facilitates dialogue on difficult ethical issues in a supportive environment.

The study of animal welfare and ethics (AWE) as part of veterinary education is important due to increasing community concerns and expectations about this topic, global pressures regarding food security, and the requirements of veterinary accreditation, especially with respect to Day One Competences. To address several key questions regarding the attitudes to AWE of veterinary students in Australia and New Zealand (NZ), the authors surveyed the 2014 cohort of these students. The survey aimed (1) to reveal what AWE topics veterinary students in Australia and NZ consider important as Day One Competences, and (2) to ascertain how these priorities align with existing research on how concern for AWE relates to gender and stage of study. Students identified triage and professional ethics as the most important Day One Competences in AWE. Students ranked an understanding of triage as increasingly important as they progressed through their program. Professional ethics was rated more important by early and mid-stage students than by senior students. Understanding the development of animal welfare science and perspectives on animal welfare were rated as being of little importance to veterinary graduates as Day One Competences, and an understanding of ''why animal welfare matters'' declined as the students progressed through the program. Combined, these findings suggest that veterinary students consider it more important to have the necessary practical skills and knowledge to function as a veterinarian on their first day in practice.

Citizens'/community juries [CJs] engage members of the public in policy decision-making processes. CJs can be employed to develop policy responses to health problems that require the consideration of both community values and scientific evidence. Based on the principles of deliberative democracy, recent reviews indicate that findings from CJs have successfully been used to influence health policy decision-making. Despite this evidence of success, there appears to be a gap between the goals of health researchers who organize CJs and the needs of policy actors and decision makers. Drawing on our experiences working with CJs and recent research on CJ methods, we describe a synopsis of the current state of the art organized around four key questions, and informed by insights from deliberative theory and critical policy studies. Our intention is to stimulate further discussion as to the types of health policy questions that can be usefully addressed through public deliberation, and provide guidance on the methodological and political dimensions that need to be considered in deciding whether a CJ is an appropriate approach for informing a policy decision-making process.

During a disaster, people may make evacuation decisions based on their companion animal's welfare, therefore exposing themselves, their companion animals, and emergency responders to increased risk for injury or death. The loss and suffering of companion animals in disasters causes deep distress, diminishing people's capacity to rebuild their lives. This scoping review presents scholarly research studies and reviews relating to people and their companion animals in the context of disasters, with an aim of informing researchers, policymakers, and practitioners and providing direction for future research. Using the Arksey and O'Malley framework, articles in scholarly journals from 2004 to 2014 are discussed. Analysis included 38 articles: 20 research studies, 12 reviews, and 6 editorials. Findings revealed 2 central themes: companion animals as a risk factor to human health and safety and companion animals being "at risk" themselves. An emerging theme was "responsibility": Who is responsible for companion animals in disasters and how? Understanding the implications of human-nonhuman animal relationships for disaster response and having a broader public consensus on what is owed to animals at times of emergency are important to community preparedness and resilience.

Objective: To determine what veterinary students in Australia and New Zealand consider important competences in compani on animal welfare and ethics (AWE) required on their first day of practice, and to explore how their priorities relate to gender and stage of study. Methods: Undergraduate students at all veterinary schools in Australia and New Zealand were sent an online survey. A subset of questions required participants to rank the importance of preselected AWE topics pertaining to companion animals. Data were analysed to determine differences in the way students of different gender or academic stage prioritised each of these AWE topics. Results: Of 3220 currently enrolled students, 851 participated in the survey: 79% were female, 17% male, 4% unspecified. Ranking of the AWE topics, from highest to lowest importance, was: neutering, companion animal husbandry, euthanasia, behaviour and training, animal breeding, over-servicing in relation to animal needs and cosmetic surgery. Female students consistently ranked competency in AWE issues surrounding neutering more highly than male students (P = 0.006). Students in senior years of study ranked the importance of competency in animal abuse/hoarding (P = 0.048), shelter medicine (P = 0.012) and animal breeding (P = 0.002) less highly than those in junior years. Conclusions: Australasian veterinary students placed more importance on competency in AWE issues associated with clinical practice (such as neutering and euthanasia) than on professional behaviours (such as over-servicing and animal breeding). However, we consider that emphasis should still be placed on developing graduate competency in the latter categories to reflect growing societal concerns about companion animal over-supply and inappropriate professional conduct.

One Health (OH) is an interdisciplinary approach aiming to achieve optimal health for humans, animals and their environments. Case reports and systematic reviews of success are emerging; however, discussion of barriers and enablers of cross-sectoral collaboration are rare. A four-phase mixed-method Delphi survey of Australian human and animal health practitioners and policymakers (n = 52) explored areas of consensus and disagreement over: (1) the operational definition of OH; (2) potential for cross-sectoral collaboration; and (3) key priorities for shaping the development of an OH response to significantly elevated zoonotic disease risk. Participants agreed OH is essential for effective infectious disease prevention and control, and on key priorities for outbreak responses, but disagreed over definitions and the relative priority of animal health and welfare and economic considerations. Strong support emerged among Australian experts for an OH approach. There was also recognition of the need to ensure cross-sectoral differences are addressed.

Responsibility is often regarded as a unified concept. However in everyday language, the term refers to a cat's cradle of related ideas and perceptions. Although there might be consensus that individuals should be ultimately responsible for their own animals during crises, individuals and groups may disagree about the norms and obligations we ought to adopt and what we owe to animals that are dependent on our care. A coherent account of responsibility for companion animals, or pets, in disasters is yet to be articulated. At the same time, there is good evidence showing that individuals and communities cope better during and after natural disasters when companion animals receive protection alongside their human families. Against this backdrop, the concept of responsibility is increasingly invoked in public communication as a motivation for pet owners to comply with emergency management plans. While top-level emergency managers seem clear on their responsibilities, studies have shown that operational-level emergency responders and service providers are less likely to know who is responsible for pets and in what ways. In this paper, we undertake a structured examination of how different concepts of responsibility are enacted around human-companion animal relationships in the context of natural disasters. Case examples from the 2009 Victorian Bushfires Royal Commission are used to examine issues and challenges in the effective translation of the concept of responsibility into operational practice. We explore how a more structured approach, with sensitivity to both human and non-human vulnerabilities, may help frontline responders, service providers and policy-makers to better engage with owners concerning responsibility for their companion animals during disasters.

Background Opportunities for community members to actively participate in policy development are increasing. Community/citizen's juries (CJs) are a deliberative democratic process aimed to illicit informed community perspectives on difficult topics. But how comprehensive these processes are reported in peer‐reviewed literature is unknown. Adequate reporting of methodology enables others to judge process quality, compare outcomes, facilitate critical reflection and potentially repeat a process. We aimed to identify important elements for reporting CJs, to develop an initial checklist and to review published health and health policy CJs to examine reporting standards. Design Using the literature and expertise from CJ researchers and policy advisors, a list of important CJ reporting items was suggested and further refined. We then reviewed published CJs within the health literature and used the checklist to assess the comprehensiveness of reporting. Results CJCheck was developed and examined reporting of CJ planning, juror information, procedures and scheduling. We screened 1711 studies and extracted data from 38. No studies fully reported the checklist items. The item most consistently reported was juror numbers (92%, 35/38), while least reported was the availability of expert presentations (5%, 2/38). Recruitment strategies were described in 66% of studies (25/38); however, the frequency and timing of deliberations was inadequately described (29%, 11/38). Conclusions Currently CJ publications in health and health policy literature are inadequately reported, hampering their use in policy making. We propose broadening the CJCheck by creating a reporting standards template in collaboration with international CJ researchers, policy advisors and consumer representatives to ensure standardized, systematic and transparent reporting.

It is a privilege to have respected colleagues engage with our definition and ethical evaluation of overdiagnosis. In our response to the commentaries, we first deal with paradigmatic issues: the place of realism, the relationship between diagnostic standards and correctness and the distinction between overdiagnosis and both false-positives and medicalisation. We then discuss issues arising across the commentaries in turn. Our definition captures the range of different types of overdiagnosis, unlike a definition limited to diagnosis of harmless disease. Certain implications do flow from our definition, as noted by commentators, but we do not view them as problematic: overdiagnoses can become beneficial diagnoses as medical knowledge and practice changes over time; inadequate systems of healthcare can produce tragic overdiagnosis, and the effectiveness of treatment partly determines whether overdiagnosis occurs. Complexity and uncertainty in balancing benefits and harms is unfortunate, but not a reason to avoid making a judgement (ideally one that reflects multiple perspectives). We reaffirm that overdiagnosis, for the foreseeable future, must be estimated at a population level and defend the importance of good-quality risk communication for individuals. We acknowledge that a lot turns on the relevance of professional communities in our definition and expand our reasoning in this regard then conclude with a note on the difference between intentions and goals. We expect that it will be some time before these matters are settled and we look forward to continue debating these matters with our colleagues.

Responsible dog ownership has been identified as a point of intervention to promote physical activity, based upon an expectation of dog walking in public space. Nevertheless, quantitative research has found variability among owners in their dog walking. In this study, we explore the implications for health promotion of such variability. We do so by drawing on the concepts of habitus and social capital to analyse qualitative interviews. Participants were recruited from a social network in a cosmopolitan city with a policy framework intended to ensure equitable access to public space for dog walkers. The analysis confirms dog ownership can promote both physical activity and social capital, to the extent of mutual reinforcement. Yet we identified patterns of care in which dogs could influence people's emotional well-being without promoting physical activity. In particular, some owners were not capable of extensive dog walking but still benefited emotionally from dog ownership and from interpersonal interactions facilitated by dog ownership. Some participants' dogs, however, could not be walked in public without risking public safety and social sanctions. Responsible dog ownership can therefore also entail not exercising dogs. Contra to the emerging ideal in health promotion, a 'dog-shaped hole' in someone's life does not always take the form of a walking companion.

Historically, the veterinary profession has understood animal welfare primarily in terms of animal health and productivity, with less recognition of animals' feelings and mental state. Veterinary students' career preferences and attitudes to animal welfare have been the focus of several international studies. As part of a survey in Australia and New Zealand, this study reports on whether veterinary students prioritize animal welfare topics or professional conduct on the first day of practice and examines links between students' career preferences and their institution, gender, and year of study. The questionnaire was designed to explore the importance that students assign to topics in animal welfare and ethics. Of the 3,320 students invited to participate in the online survey, a total of 851 students participated, representing a response rate of 25.5%. Students' preferences increased for companion-animal practice and decreased for production-animal practice as they progressed through their studies. Females ranked the importance of animal welfare topics higher than males, but the perceived importance declined for both genders in their senior years. In line with previous studies, this report highlighted two concerns: (1) the importance assigned to animal welfare declined as students progressed through their studies, and (2) males placed less importance overall on animal welfare than females. Given that veterinarians have a strong social influence on animal issues, there is an opportunity, through enhanced education in animal welfare, to improve student concern for animal welfare and in turn improve animal care and policy making by future veterinarians.

The One Health agenda comprises efforts across multiple sectors and disciplines to coordinate the interdependence of human existence with nonhuman animals and within ecosystems. Thus far, however, One Health has mainly been construed as an ecological approach to the prevention and control of infectious diseases, especially those which are zoonotic, meaning that they can be transmitted from non‐human animals to humans. Yet the conceptual underpinnings of One Health remain ambiguous and ill‐defined, especially as the concept explicitly extends the notion of ‘health’ to non‐human animals and environments. Furthermore, the implications of the One Health concept for emotional and social well‐being have received little attention, implying that ‘health’ consists merely of an absence of physical disease, injury or illness. Anthropologists are among those who are well‐positioned to lending depth and nuance to One Health research and practice, and in doing so, environmental anthropology, medical anthropology and science and technology studies (STS) may become more integrated. To that end, and against the background of a comparative analysis of central policies adopted by the World Health Organization (WHO) and World Organisation for Animal Health (OIE), this chapter contributes to the conceptualisation of One Health promotion.

Health promotion views collaborations between local governments and citizens as key to improving health and lessening inequities in urban areas. Public parks, which are typically managed by local governments, are key settings for promoting physical activity, positive social interactions and overall well-being. Yet research on civic participation in park management is essentially absent from the health promotion literature. When the City of Calgary began to implement a new policy on off-leash dogs in parks, we had an opportunity to study civic participation in decision-making. We did so by examining policy documents, participating in meetings and conducting interviews. Off-leash parks have particular relevance for health promotion because they may support physical activity and networking for some, but may escalate conflict and deter park use amongst others. In this case study, the local government engaged citizens in developing an overarching off-leash policy for the city as a whole and in implementing the new policy at the level of neighbourhoods. Of the first three parks to be considered under the new policy, an off-leash area was ultimately designated in just one: a park located in a disadvantaged neighbourhood. By exploring this unexpected outcome, our case study suggests that public engagement, as practiced by local policymakers, may differ from community participation, as endorsed in health promotion. Further reflection on the meaning of 'public' is warranted in public health.

In late 2014, the outbreak of Ebola virus disease (EVD) in West Africa was at its peak. Th ose infected numbered in the tens of thousands. "Hotspots" with multiple cases appeared across four nations, both in overcrowded major cities and in isolated rural villages. Hospitals were overfl owing. Th ere were insuffi cient laboratory facilities and trained health care workers to diagnose cases swiftly; and disintegrated or absent public infrastructure in all domains, from roads and sewers to epidemiologists and health promoters, hampered international responders. Nurses and doctors-already far overstretched, and servicing absurd populations at a ratio of 1:1000 even before the outbreak-were often among the fi rst infected and dead.

Overdiagnosis is an emerging problem in health policy and practice: we address its definition and ethical implications. We argue that the definition of overdiagnosis should be expressed at the level of populations. Consider a condition prevalent in a population, customarily labelled with diagnosis A. We propose that overdiagnosis is occurring in respect of that condition in that population when (1) the condition is being identified and labelled with diagnosis A in that population (consequent interventions may also be offered); (2) this identification and labelling would be accepted as correct in a relevant professional community; but (3) the resulting label and/or intervention carries an unfavourable balance between benefits and harms. We identify challenges in determining and weighting relevant harms, then propose three central ethical considerations in overdiagnosis: the extent of harm done, whether harm is avoidable and whether the primary goal of the actor/s concerned is to benefit themselves or the patient, citizen or society. This distinguishes predatory (avoidable, self-benefiting), misdirected (avoidable, other-benefiting) and tragic (unavoidable, other-benefiting) overdiagnosis; the degree of harm moderates the justifiability of each type. We end with four normative challenges: (1) methods for adjudicating between professional standards and identifying relevant harms and benefits should be procedurally just; (2) individuals, organisations and states are differently responsible for addressing overdiagnosis; (3) overdiagnosis is a matter for distributive justice: the burdens of both overdiagnosis and its prevention could fall on the least-well-off; and (4) communicating about overdiagnosis risks harming those unaware that they may have been overdiagnosed. These challenges will need to be addressed as the field develops.

One Health (OH) is a novel paradigm that recognizes that human and non-human animal health is interlinked through our shared environment. Increasingly prominent in public health responses to zoonoses, OH differs from traditional approaches to animal-borne infectious risks, because it also aims to promote the health of animals and ecological systems. Despite the widespread adoption of OH, culling remains a key component of institutional responses to the risks of zoonoses. Using the threats posed by highly pathogenic avian influenza viruses to human and animal health, economic activity and food security as a case exemplar, we explore whether culling and other standard control measures for animal-borne infectious disease might be justified as part of OH approaches. Our central premise is that OH requires us to reformulate 'health' as universal good that is best shared across species boundaries such that human health and well-being are contingent upon identifying and meeting the relevant sets of human and non-human interests and shared dependencies. Our purpose is to further nascent discussions about the ethical dimensions of OH and begin to describe the principles around which a public health agenda that truly seeks to co-promote human and non-human health could potentially begin to be implemented.

In late 2014, the outbreak of Ebola virus disease (EVD) in West Africa was at its peak. Th ose infected numbered in the tens of thousands. "Hotspots" with multiple cases appeared across four nations, both in overcrowded major cities and in isolated rural villages. Hospitals were overfl owing. Th ere were insuffi cient laboratory facilities and trained health care workers to diagnose cases swiftly; and disintegrated or absent public infrastructure in all domains, from roads and sewers to epidemiologists and health promoters, hampered international responders. Nurses and doctors-already far overstretched, and servicing absurd populations at a ratio of 1:1000 even before the outbreak-were often among the fi rst infected and dead.

The One Health agenda comprises efforts across multiple sectors and disciplines to coordinate the interdependence of human existence with nonhuman animals and within ecosystems. Thus far, however, One Health has mainly been construed as an ecological approach to the prevention and control of infectious diseases, especially those which are zoonotic, meaning that they can be transmitted from non‐human animals to humans. Yet the conceptual underpinnings of One Health remain ambiguous and ill‐defined, especially as the concept explicitly extends the notion of ‘health’ to non‐human animals and environments. Furthermore, the implications of the One Health concept for emotional and social well‐being have received little attention, implying that ‘health’ consists merely of an absence of physical disease, injury or illness. Anthropologists are among those who are well‐positioned to lending depth and nuance to One Health research and practice, and in doing so, environmental anthropology, medical anthropology and science and technology studies (STS) may become more integrated. To that end, and against the background of a comparative analysis of central policies adopted by the World Health Organization (WHO) and World Organisation for Animal Health (OIE), this chapter contributes to the conceptualisation of One Health promotion.